Settlement Agreement
under the Americans with Disabilities Act of 1990

between the

United States of America

and

Silver Hill Hospital,for Complaint DJ# 202-14-44

1. This action was initiated by a complaint filed with the United States Department of Justice (the Department) against the Silver Hill Hospital, DJ# 202-14-44. The complaint was investigated by the Department under the authority granted by section 308(b) of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. § 12188.

3. The United States, acting through the Attorney General, has statutory authority to enforce title III of the ADA, 42 U.S.C. §§ 12101 et seq. As such, the United States Department of Justice investigated Silver Hill Hospital to address the interests of the public and of an individual complainant (United States Complainant).

4. The United States Complainant alleged that, based on her disability, Silver Hill Hospital subjected her to the following discrimination, which occurred throughout the duration of her inpatient and outpatient services from September 1996 to April 1997:

A. a denial of the opportunity to participate in or benefit from the goods, services, facilities, privileges, advantages, or accommodations of the Hospital;

B. an opportunity to participate in or benefit from the goods, services, facilities, privileges, advantages, or accommodations that are not equal to that afforded to other individuals;

C. a denial of the opportunity to participate in such programs or activities that are not separate or different;

D. a failure to take those steps that may be necessary to ensure that as an individual with a disability, she is not excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services; and

E. a failure to furnish appropriate auxiliary aids and services where necessary to ensure effective communication, including but not limited to, the provision of qualified sign language interpreters, notetakers, computer-aided transcription, open and closed captioning, telecommunications devices for deaf persons (TDDs), videotext displays, or other effective methods of making aurally delivered materials available to individuals with hearing impairments.

5. The United States alleges that Silver Hill Hospital discriminated against a person who is hard of hearing by failing to provide her with the full and equal enjoyment of the Hospitals goods, services, programs, and activities, and by failing to provide appropriate auxiliary aids and services when necessary for effective communication.

6. The United States Complainant is a person who is hard of hearing and who is an individual with a disability within the meaning of the ADA, 42 U.S.C. § 12102(2), and its implementing regulation at 28 C.F.R. pt. 36, and Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794 (the Rehabilitation Act), and its implementing regulation at 45 C.F.R. pt. 84.

8. Silver Hill Hospital receives federal funds in the form of Medicaid and Medicare payments and is thus a federally assisted program within the meaning of Section 504 of the Rehabilitation Act, 29 U.S.C. § 794.

10. This Agreement defines the obligations under the ADA of Silver Hill Hospital with respect to:

A. persons who are deaf or hard of hearing or who have speech impairments and who are:

(1) inpatients or outpatients of Silver Hill Hospital (Patients); or

(2) persons who will be consulted or would otherwise reasonably be expected to communicate with Hospital Personnel regarding health care issues of Patients (Companions), and

B. persons who are not deaf or hard of hearing and who do not have speech impairments and who are:

(1) Patients with Companions who are deaf or hard of hearing or who have speech impairments;

(2) Companions of Patients who are deaf or hard of hearing or who have speech impairments; or

(3) associated with Companions who are deaf or hard of hearing or who have speech impairments.

11. Without conceding the allegations of the United States, or the possible defense of Silver Hill Hospital, both parties agree that it is in their best interests to resolve this matter promptly and without protracted litigation.

13. The term Patient shall be broadly construed to include any individual who is seeking or receiving health care services (including mental health services) from the Hospital.

14. The term "Hospital Personnel" shall mean: all Silver Hill Hospital employees, as well as independent contractors with contracts to work on a substantially full-time basis for Silver Hill Hospital (or on a part-time basis exclusively for the Hospital), including, without limitation, nurses, physicians, social workers, technicians, admitting personnel, security staff, counselors, and therapists, and all volunteers, who have or are likely to have direct contact with Patients or Companions.

15. The term Parties shall mean: Silver Hill Hospital and the United States, acting by and through the Department of Justice.

16. The term "qualified sign language interpreter," "oral interpreter," or "interpreter" shall mean: an interpreter who is able to interpret competently, accurately, and impartially, both receptively and expressively, using any specialized terminology necessary for effective communication in the hospital setting to a Patient or a Companion who is deaf or hard of hearing or who has a speech impairment. A qualified sign language interpreter is someone who can communicate effectively with an individual given the particular individuals language skills and history. In addition, someone who has only a rudimentary familiarity with sign language or finger spelling is not a "qualified sign language interpreter" under this Agreement. Likewise, someone who is fluent in sign language but who does not possess the ability to process spoken communication into the proper signs or to observe someone else signing and change their signed or fingerspelled communication into spoken words is not a qualified sign language interpreter. 28 C.F.R. § 36.104. Someone who is a qualified interpreter for a person who uses American Sign Language may not be a qualified interpreter for an individual who uses a different sign language, such as one based on Spanish rather than English. Likewise, an interpreter who knows tactile interpreting may be the only interpreter who is qualified to interpret for someone who is both deaf and blind.

17. The term "Standards" shall mean: the ADA Standards for Accessible Design, as set forth at 28 C.F.R. pt. 36, App. A.

18. The term "TTY's" or "TDD's" shall mean: devices that are used with a telephone to communicate with persons who are deaf or hard of hearing or who have speech impairments by typing and reading communications.

PROHIBITION OF DISCRIMINATION

19. Non-Discrimination. Silver Hill Hospital shall not deny its goods or services to anyone based on the fact that the person is deaf or hard of hearing or has a speech impairment or is associated with someone known to be deaf or hard of hearing or has a speech impairment.

20. Discrimination by Association. Silver Hill Hospital shall not deny equal services, accommodations, or other opportunities to any individual because of the known relationship of the person with someone who is deaf or hard of hearing or who has a speech impairment.

21. Retaliation and Coercion. Silver Hill Hospital agrees not to retaliate against or coerce in any way any person who is trying to exercise his or her rights under this Agreement or the ADA.

EFFECTIVE COMMUNICATION

GENERAL OBLIGATIONS

22. Establishment of an Effective Communications Program (Program) to Provide Appropriate Auxiliary Aids and Services. Within ninety (90) days of the effective date of this Agreement, Silver Hill Hospital will design and institute a Program to effectively implement the provisions of this Agreement, including without limitation:

developing, coordinating, and overseeing the development of specific procedures to implement fully this Agreement;

scheduling, announcing, and promoting all training required by this Agreement;

coordinating the community outreach required by this Agreement; and

drafting, maintaining, and providing all reports required by this Agreement.

23. Simultaneously with the establishment of the Program, Silver Hill Hospital shall designate one or more individuals (Program Administrators), who will maintain full information about access to, and the operation of, the Program. Program Administrators shall be available to Silver Hill Hospital Staff, Patients, and Patients Companions, twenty-four (24) hours a day, seven (7) days a week, to answer questions and provide appropriate assistance regarding immediate access to, and proper use of, the appropriate auxiliary aids and services required by this Agreement. Such Program Administrators shall know where the appropriate auxiliary aids are stored and how to operate them, and will be responsible for their maintenance, repair, replacement, and distribution. Silver Hill will circulate broadly within the Hospital the names, telephone numbers, functions, and office locations of such Program Administrators, including a TTY telephone number that may be called by Patients and Companions who are deaf or hard of hearing or who have speech impairments in order to obtain the assistance of such Program Administrators.

24. Simultaneously with the establishment of the Program, Silver Hill Hospital shall maintain a combination voice/TTY telephone line or a dedicated TTY telephone line, shall publicize its purpose and telephone number broadly within the Hospital and to the public, shall respond to outside telephone inquiries during normal business hours, and shall maintain a recording system for inquiries received after normal business hours. Silver Hill Hospital shall respond to these outside voice and TTY inquiries as promptly as it responds to other outside inquiries of the Hospital and its services.

Provision of Appropriate Auxiliary Aids and Services
Under the Program

25. Immediate Aids and Services. Within sixty (60) days of the effective date of this Agreement, Silver Hill Hospital shall provide, to Patients and Companions who are deaf or hard of hearing or who have speech impairments, whichever of the following appropriate auxiliary aids and services (singly or in combination) that may be necessary for effective communication, as soon as practicable after making such determination:

27. Assessment. The determination of which appropriate auxiliary aids and services are necessary, and the timing, duration and frequency with which they will be provided, shall be made by Hospital Personnel who are otherwise primarily responsible for coordinating and/or providing patient care services, in consultation with the person with a disability where possible. The assessment will take into account all relevant facts and circumstances, including without limitation the nature, length, and importance of the communication at issue, as well as the individual's communication skills, knowledge, the Patients health status or changes thereto, the reasonably foreseeable health care activities of the Patient (e.g., individual, group, and family therapy sessions, crisis intervention, educational services, family program, medication assessment and management, medical tests or procedures, rehabilitation and treatment services, meetings with health care professionals or social workers, or discussions concerning billing, insurance, self-care, prognoses, diagnoses, history and discharge), and the availability at the required times, day or night, of appropriate auxiliary aids and services.

A. Initial assessment. The initial assessment will be made at the time an appointment is scheduled or on the arrival of the Patient or Companion at Silver Hill Hospital, whichever is earlier. Hospital Personnel will perform and document a communication assessment as part of each initial inpatient assessment which is required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Completion of communication assessments will be documented in the Patient's record and a copy of the assessment shall be provided to the Patient immediately upon request. Silver Hill Hospital may use, but is not required to use, the Model Communication Assessment Form provided as Exhibit 1 to this Agreement.

B. Ongoing assessments. If a Patient or a Companion who is deaf or hard of hearing or who has a speech impairment has an ongoing relationship with Silver Hill Hospital, the provision of appropriate auxiliary aids or services will be reconsidered as part of each routine assessment of an inpatient, or on a regular basis with respect to other Patients and Companions. Hospital Personnel shall keep appropriate records that reflect the ongoing assessments, such as notations in Patients' records. Patients shall be provided with a copy of any ongoing assessments immediately upon request.

28. Complaint Resolution. Silver Hill Hospital will maintain an effective complaint resolution mechanism regarding use of the Program by Patients and Companions and will maintain records of all complaints filed and actions taken with respect thereto. A copy of the written complaint resolution process shall be provided to the Department within thirty (30) days of the effective date of this Agreement.

29. Prohibition of Surcharges. All appropriate auxiliary aids and services required by this Agreement will be provided free of charge to the Patient or Companion who is deaf or hard of hearing or who has a speech impairment.

30. Individual Notice In Absence of Request. If a Patient or a Companion who is deaf or hard of hearing or who has a speech impairment does not request appropriate auxiliary aids or services but Hospital Personnel have reason to believe that such person would benefit from appropriate auxiliary aids or services for effective communication, Silver Hill Hospital will specifically inform the person that appropriate auxiliary aids and services are available free of charge.

31. Communication with Inpatients and Companions. Silver Hill Hospital will take appropriate steps to ensure that all Hospital Personnel having contact with a Patient or Companion who is deaf or hard of hearing or who has a speech impairment are made aware of such person's disability so that effective communication with such person will be achieved.

SIGN LANGUAGE AND ORAL INTERPRETERS

32. Circumstances Under Which Sign Language and Oral Interpreters Will Be Provided. Silver Hill Hospital shall provide qualified sign language interpreters to Patients and Companions who are deaf or hard of hearing or who have speech impairments and whose primary means of communication is sign language, and qualified oral interpreters to such Patients and Companions who rely primarily on lip reading, as necessary for effective communication. The determination of when such interpreters shall be provided to Patients or Companions shall be made as set forth in paragraph 27 (Assessment) above. The following are examples of circumstances when it may be necessary to provide interpreters:

determination of a Patient's medical, psychiatric, psychosocial, nutritional and functional history or description of condition;

provision of Patients' rights, informed consent or permission for treatment;

religious services and spiritual counseling;

explanation of living wills or powers of attorney (or their availability);

provision of mental health evaluations, individual, group and family therapy, counseling, and other therapeutic activities, including grief counseling and crisis intervention;

explanation of complex billing or insurance issues that may arise; and

provision of educational services and educational presentations.

The foregoing list of circumstances is neither exhaustive nor mandatory, and shall not imply that there are not other circumstances when it may be appropriate to provide interpreters for effective communication nor that an interpreter must always be provided in these circumstances.

33. Chosen Method for Obtaining Interpreters. The Department acknowledges that subsequent to the initiation of investigations, Silver Hill Hospital agreed to participate in the interpreter on-call system established by the defendant Hospitals in Avenna et al. v. Middlesex Memorial Hospital et al. (August 12, 1999, Telephone conversation between Department investigator and Susan Gralnick, RN, MPA, Silver Hill Hospital). The on-call system is facilitated by Family Services Woodfield (FSW), Bridgeport, CT, to provide qualified sign language and oral interpreters at the request of the Hospital.1 Within ten (10) days of the effective date of this Agreement, Silver Hill Hospital shall provide to the United States a signed copy of the current contract into which it has entered with FSW (the agency). The contract requires the agency to maintain a response time of one hour or less in at least 80 percent of non-scheduled incidents within any six (6) month period (excluding any incident when the assessment calls for an interpreter to be provided at a later time), measured from the time beginning 10 minutes after it is determined that an interpreter is necessary for effective communication with a Patient or Companion who is deaf or hard of hearing or who has a speech impairment.

A. The contract will require a response time of two (2) hours or less in 100 percent of non-scheduled incidents.

B. The contract may provide that the foregoing response times are subject to force majeure events, that is, any response time that is delayed because of a force majeure event shall be excluded from the determination whether the prescribed response criteria have been met. Force majeure events shall be events outside the reasonable control of Silver Hill Hospital, the agency, or the interpreter called to respond, such as weather problems and other Acts of God, unanticipated illness or injury of the interpreter, and unanticipated transportation problems (including without limitation mechanical failure of the interpreters automobile, automobile accidents, and roadway obstructions).

C. If the contract expires or is terminated by either party, Silver Hill Hospital will promptly so notify the United States and provide the United States with a copy of a new contract that meets the above conditions within thirty (30) days of the expiration or termination of the previous contract.

34. Free-lance Interpreters. Within sixty (60) days of the effective date of this Agreement, Silver Hill Hospital will compile and maintain as current a list of all known free-lance sign language and oral interpreters who reside within 50 miles of Silver Hill Hospital. Silver Hill Hospital should obtain, but is not required to limit themselves to using, a list supplied by the Registry for Interpreters for the Deaf or a local affiliate, to identify qualified free-lance interpreters.

35. Notice to Patients and Companions Who Are Deaf or Hard of Hearing or Who Have Speech Impairments. As soon as Hospital Personnel have determined that an interpreter is necessary for effective communication with a Patient or a Companion who is deaf or hard of hearing or who has a speech impairment, and again one hour later, Silver Hill Hospital will inform such person (or a family member or friend, if such person is not available) of the current status of efforts being taken to secure the appropriate auxiliary aids and services on his or her behalf. Additional updates shall be provided thereafter as necessary until such aids and services are secured.

36. Other Means of Communication. Silver Hill Hospital agrees that between the time an interpreter is requested and when an interpreter arrives, Hospital Personnel will continue to try to communicate with the Patient or Companion who is deaf or hard of hearing or who has a speech impairment for such purposes and to the same extent as they would have communicated with the person but for the hearing impairment, using all available methods of communication (e.g., provision of writing utensils and paper). This provision in no way lessens Silver Hill Hospitals obligation to provide qualified interpreters in a timely manner as required by this Agreement.

37. Restricted Use of Certain Persons to Facilitate Communication. Due to confidentiality, potential emotional involvement, and other factors that may adversely affect the ability to facilitate communication, Silver Hill Hospital shall never require or coerce a family member, companion, case manager, advocate, or friend of a Patient or Companion who is deaf or hard of hearing or who has a speech impairment to interpret or facilitate communications between Hospital Personnel and such Patient or Companion. In any case, such person shall be used to interpret or facilitate communication only if the Patient or Companion who is deaf or hard of hearing or who has a speech impairment does not object, if such person wishes to provide such assistance, and if such use is necessary or appropriate under the circumstances, giving appropriate consideration to any privacy issues that may arise.

38. Procedures for Obtaining Interpreters. Beginning on the effective date of this Agreement, Silver Hill Hospital shall take the following steps, in order, when it receives notice that a Patient or Companion requires sign language or oral interpreters for effective communication, until a qualified interpreter is secured or the steps have been exhausted:

A. Request an interpreter (he or she must be qualified to interpret for the specific individual who will be using the services) from each of the interpreters or agencies with whom Silver Hill Hospital has an ongoing contract for qualified sign language or oral interpreter services;

B. Exert reasonable efforts (which shall be deemed to require no fewer than five (5) telephone inquiries) to contact any free-lance interpreters or other interpreting agencies already known to Silver Hill Hospital and request their services; and

C. Inform the Patient or Companion who is deaf or hard of hearing or who has a speech impairment (or, if unavailable, the persons companions) of the efforts taken to secure a qualified interpreter and that the efforts have failed, and follow up on reasonable suggestions for alternate sources of interpreters, such as contacting an interpreter known to that person.

39. Staff Interpreters. Silver Hill Hospital may, but shall have no obligation to, satisfy its obligations under this Agreement by hiring or otherwise contracting with qualified staff interpreters. Staff interpreters must meet the definition of "qualified interpreters." Patients and Companions who are provided with staff interpreters must have the same level of coverage (for both duration and frequency) as Silver Hill Hospital is otherwise obligated to provide under this Agreement. Silver Hill Hospital may assign other duties to staff interpreters. To the extent that a Hospital does not have staff interpreters or a staff interpreter is not available when needed, Silver Hill Hospital will follow the procedures set forth above to obtain the services of qualified interpreters.

TECHNOLOGY

Telephones and Related Equipment

40. Public Telephones. As soon as practicable but no later than ninety (90) days after the effective date of this Agreement, Silver Hill Hospital will provide the following:

A. TTY's in public areas. Silver Hill Hospital will make a TTY device available wherever a public telephone is made available (whether public pay telephone, public closed circuit telephones, or otherwise). To satisfy this provision, Silver Hill Hospital can permanently install the required TTY's or make available a sufficient number of portable TTY's. Standards §§ 4.1, 4.31.9. Each such TTY, whether permanently installed or portable, shall comply with the Standards set forth in Schedule A, attached.

B. Shelves and outlets. Wherever portable TTY's are made available as an alternative to installed TTY's, and wherever there is a bank of three or more public telephones, Silver Hill Hospital will provide shelves and electrical outlets that comply with the Standards set forth in Schedule A.

C. Signs indicating the location of TTY's.

(1) Wherever public telephones are available but TTY's are not permanently installed, Silver Hill Hospital will post signs complying with the Standards set forth in Schedule A. Such signs will indicate the location of the nearest portable or permanently installed TTY's; and

(2) Wherever TTY's are permanently installed, Silver Hill Hospital will post signs complying with the Standards set forth in Schedule A to indicate their location.

D. Volume control telephones. Silver Hill Hospital will ensure that no less than twenty-five (25) percent of all of its public telephones are equipped with volume control mechanisms, plus at least one public telephone in or adjacent to each building on the Silver Hill campus which has a public telephone. Each volume control telephone shall comply with the Standards set forth in Schedule A. Silver Hill Hospital will ensure that volume control phones are dispersed among all public telephones throughout Silver Hill Hospital. Silver Hill Hospital will ensure that signs complying with the Standards set forth in Schedule A are displayed at each volume control telephone.

E. Hearing aid compatible telephones. Silver Hill Hospital will ensure that no less than twenty-five (25) percent of all of its public telephones are hearing aid compatible, plus at least one public telephone in or adjacent to each building with a public telephone. Silver Hill Hospital will ensure that hearing aid compatible telephones are dispersed among all public telephones throughout Silver Hill Hospital. Standards § 4.1, 4.31.5.

F. Storage and availability of equipment. Portable equipment for use in public areas shall be stored in places that are readily accessible to all Hospital Personnel who have Patient contact at all times of the day and night. All Hospital Personnel will be notified of the storage location that is closest to their work area(s). The equipment is to be stored at the appropriate supervised location (e.g., nurses' station, admission desk, etc.) closest to the public phone for which the equipment is to be made available. Such equipment shall be made available to Patients or Companions who are deaf or hard of hearing or who have speech impairments as soon as practicable but no more than ten (10) minutes from the time of the persons request.

41. Telephones in Patient Rooms. Within ninety (90) days of the effective date of this Agreement:

A. Portable access technology - defined. In treatment units where Silver Hill Hospital permits telephones and televisions in Patients rooms, Silver Hill will make available portable access technology. Such technology, as referred to in this section, shall include TTY's with printout capability, visual notification devices for incoming telephone calls, volume control telephones, and telephones that are hearing aid compatible. Silver Hill Hospital shall ensure that each volume control telephone and each visual notification device for incoming telephone calls complies with the Standards set forth in Schedule A hereto.

B. Portable access technology - general obligation. Silver Hill Hospital will make portable access technology available to Patients and Companions who are deaf or hard of hearing or who have speech impairments and who are admitted to (or are accompanying Patients who are admitted to) rooms equipped with a telephone. In units of Silver Hill Hospital where Patients normally do not have telephones in their rooms, if hearing Patients are given access to common area telephones other than the public phones identified in this Agreement, the Hospital will maintain in each such unit appropriate portable access technology that can be used by Patients and Companions who are deaf or hard of hearing or who have speech impairments so that such persons have equal access to make outgoing calls and receive incoming calls as do hearing persons.

C. Electrical outlets. Each Patient room with a telephone shall have an electrical outlet within four feet of the telephone connection to facilitate the use of a TTY device, or Silver Hill Hospital will provide when needed a heavy-duty extension cord for Patient rooms that are not so equipped.

D. Timeliness. Within ninety (90) days of the effective date of this Agreement, Silver Hill Hospital will make the equipment required by this section available within thirty (30) minutes of a Patient's arrival in a patient room, regardless of the hour of the day or night. Silver Hill Hospital will notify all relevant Hospital Personnel of the availability and location of this equipment.

Visual Alarms

42. Areas of Common Use. Within ninety (90) days of the effective date of this Agreement, Silver Hill Hospital, which has audible alarms in public areas, will add visual alarms complying with the Standards set forth in Schedule B. Public areas include restrooms and any other general usage areas (e.g., meeting rooms, teaching amphitheaters, hallways, lobbies, libraries, gymnasiums and other recreational facilities, cafeterias, and any other area for common use).

A. Exception. To the extent that the present capabilities of the existing audible alarm system are not sufficient to handle an electrical load that would allow a retrofit to include visual alarms without extensive re-wiring, such visual alarms will be added within two (2) years of the effective date of this Agreement. In the interim, an on-duty staff member will be assigned each shift to take responsibility for immediately notifying Patients or Companions who are deaf or hard of hearing when the audible alarm sounds.

B. This exception does not apply to any area of the Hospital that is subject to the new construction or alterations provision of the ADA (42 U.S.C. § 12183(a)(1), (2); 28 C.F.R. §§ 36.401 (new construction), 36.402 (alterations)). Such areas of the Hospital should already comply with such Standards and those areas which do not presently comply with such Standards will be retrofitted within one hundred eighty (180) days of this Agreement, without regard to the expense or difficulty of such retrofit.

43. Patient Rooms. Within ninety (90) days of the effective date of this Agreement, the Hospital will make portable visual alarms available for Patient rooms when a Patient or Companion who is deaf or hard of hearing is residing in or is anticipated to spend significant periods of time in such a room. This requirement only applies to those Patient rooms in which hearing Patients are reasonably able to hear an audible alarm, whether the audible speaker is located in the room itself, in the hallway, or in another relatively close location. The Hospital shall ensure that each Patient room into which a visual alarm is to be placed complies with the Standards set forth in Schedule B hereto. The Hospital shall not be required to provide portable visual alarms in a Patient room if a person who may suffer from seizures that may be triggered by a visual alarm is reasonably expected to spend significant amounts of time in the room.

44. The Hospital will develop written evacuation procedures within thirty (30) days of this Agreement which outline the evacuation protocol for people who are deaf or hard of hearing.

Captioning and Decoders

45. Televisions and Caption Decoders. Within ninety (90) days of the effective date of this Agreement, Silver Hill Hospital will make closed captioning decoders available to Patients or Companions who are deaf or hard of hearing as part of available television services at no additional cost, except for televisions that have the built-in capability to display captions. 28 C.F.R. § 36.303(e).

A. Clearly stated directions for use of the closed caption capability shall be in the Patient Handbook (or equivalent publication) or otherwise available in each patient room or public area containing a television with captioning capability. The directions for operating the closed caption function shall also accompany all closed caption decoders for standard television sets.

46. Duty to Provide Visual Programs in a Manner That Is Accessible to Persons with Hearing Impairments.

A. It is expressly agreed that Silver Hill Hospital has an obligation to provide captions on any program broadcast over the public airways or commercial cable television services, where such captions are not already integrated into the program.

B. Beginning no later than ninety (90) days from the effective date of this Agreement, if Silver Hill Hospital solicits a third party, parent company, or affiliated health care provider to produce or provide video programs that may be broadcast within Silver Hill Hospital to Patients or Companions who are deaf or hard of hearing, it will ensure that the program is captioned, unless, under the circumstances, doing so would impose an undue burden. 28 C.F.R. § 36.303. Commercial videos available to the general public shall not be subject to this requirement.

C. Beginning no later that ninety (90) days from the effective date of this Agreement, if Silver Hill Hospital produces internally a pre-recorded program for broadcast within Silver Hill Hospital, it will ensure that the program is made accessible to Patients and Companions who are deaf or hard of hearing, whether by captioning such program or by providing a transcript or sign language interpreter whenever it is viewed by a Patient or Companion who is deaf or hard of hearing. If the program is not captioned, the method of access delivery must be tailored to the needs of the Patient or Companion who is deaf or hard of hearing. For instance, if the person does not know sign language, Silver Hill Hospital may provide effective communication through a transcript. In most circumstances, captioning will be regarded as providing effective communication with all persons who are deaf or hard of hearing or who have speech impairments, regardless of the communication skills and history of such persons (though repeated screenings may be necessary if the person who is deaf or hard of hearing cannot read English at the rate required to keep pace with the audible portion of the program). If, however, the contents of a program are sufficiently important to require precise communication of its contents, Silver Hill Hospital will take additional measures to ensure effective communication.

D. Beginning no later than ninety (90) days from the effective date of this Agreement, if Silver Hill Hospital produces its own live broadcasts, then it will make most such programs as accessible to Patients and Companions who are deaf or hard of hearing as they are to others. Captioning is one way, but not the only way, to make such programs accessible to Patients and Companions who are deaf or hard of hearing. Silver Hill Hospital can also choose to provide sign language interpreters (if the person who is deaf or hard of hearing or who has a speech impairment uses sign language) or written scripts prepared in advance of the live broadcast. In order to determine which programs should be captioned, Silver Hill Hospital may prioritize and consider such factors as the importance and length of the program, as well as any significant difficulty or expense in captioning the program or displaying the captions, given the location of its filming or viewing.

47. Client Education. Silver Hill Hospital shall ensure that each Patient and Companion who is deaf or hard of hearing or who has a speech impairment who is provided with portable access technology is appropriately directed as to the proper use of such equipment.

48. Acquisition of Additional Equipment. In addition to the equipment required above, Silver Hill Hospital shall purchase and/or rent such additional equipment as is reasonably needed to replace defective units. Silver Hill Hospital shall also monitor developments in technology and shall upgrade such equipment when and if it deems it reasonable and appropriate to do so.

NOTICE TO COMMUNITY

49. Policy Statement. Within thirty (30) days of the effective date of this Agreement, Silver Hill Hospital shall post and maintain signs of conspicuous size and print at all admitting stations, and wherever a Patients Bill of Rights is required by law to be posted. Such signs shall be to the following effect:

Sign language and oral interpreters, TTYs, assistive listening devices, and other auxiliary aids and services are available free of charge to people who need them for effective communication in programs areas and patient rooms where televisions and telephones are permitted. For assistance, please go to the nearest Nurses Station, or contact the Program Office at ____________ (voice/TTY), room ____________.

These signs will include the international symbols for interpreters and TTYs. An example is attached hereto as Exhibit 2.

50. Advertisements. Within ninety (90) days of the effective date of this Agreement, Silver Hill Hospital will take appropriate steps to publicize in the community Silver Hill Hospital's commitment to provide all of its services to Patients and Companions who are deaf or hard of hearing or who have speech impairments. Such publicity shall be deemed satisfied by the purchase of reasonable advertising space at least twice in newspapers of general circulation serving the same community as is served by Silver Hill Hospital, which advertisements include a statement that all appropriate auxiliary aids and services, including qualified sign language interpreters, TTY's, and assistive listening devices will be provided free of charge upon request, and include appropriate telephone numbers and instructions detailing how to access Silver Hill Hospital telephonically for information about the Program and/or other inquiries. Annually thereafter, Silver Hill Hospital shall take reasonable steps to publicize the existence of the Program to the deaf and hard of hearing community.

51. Patient Handbook. Silver Hill Hospital will include in all future printings of its Patient Handbook (or equivalent) and all similar publications a statement to the following effect:

To ensure effective communication with Patients and their companions who are deaf or hard of hearing or who have speech impairments, we provide appropriate auxiliary aids and services free of charge, such as: sign language and oral interpreters, TTY's, notetakers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, closed caption decoders, and open and closed captioning of most Hospital programs.

Please ask your nurse or other Hospital personnel for assistance, or contact the Program Office at _________________ (voice or TTY), room ___________________.

52. Notice to Hospital Personnel and Physicians. Silver Hill Hospital shall publish, in an appropriate form, a written policy statement regarding Silver Hill Hospital's policy for effective communication with persons who are deaf or hard of hearing or who have speech impairments. The policy statement shall include, but is not limited to, language to the following effect:

If you recognize or have any reason to believe that a patient, relative, or a close friend or companion of a patient is deaf or hard of hearing or has speech impairments, you must advise the person that appropriate auxiliary aids and services will be provided free of charge. If you are the responsible health care provider, you must ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the appropriate Program Administrator. This offer and advice must likewise be made in response to any overt request for appropriate auxiliary aids or services.

Silver Hill Hospital shall distribute this document within sixty (60) days of the effective date of this Agreement to all Hospital Personnel and affiliated physicians (physicians with practicing or admitting privileges) and other professionals, and to all new Hospital Personnel and newly affiliated physicians and other professionals upon their employment or affiliation with Silver Hill Hospital.

TRAINING OF HOSPITAL PERSONNEL

53. Comprehensive Training. Within ninety (90) days of the date of this Agreement, Silver Hill Hospital will provide one or more training sessions for Hospital Personnel, affiliated physicians, and others associated with Silver Hill Hospital.

54. Content of Comprehensive Training. Such training shall be sufficient in duration and content to train a reasonable number of Hospital Personnel in access to the Program, use of the Program, and sensitivity to the needs of the deaf community. Such training shall include topics relevant to the health care needs of the deaf and hard of hearing, such as the various degrees of hearing impairment, language and cultural diversity in the deaf community, dispelling myths and misconceptions about persons who are deaf, identification of communication needs of persons who are deaf, the unique needs and problems encountered by late-deafened individuals, psychological implications of deafness and its relationship to interaction with hearing health care professionals, recommended and required charting procedures, types of auxiliary aids and services as required under this Agreement,2 the proper use and role of qualified sign language interpreters, procedures and methods for accessing sign language and oral interpreter agencies as well as free-lance interpreters, the existence in Silver Hill Hospital of a Program Office and Program Administrators, making and receiving calls through TTYs and through telephone relay service providers, third party resources which can provide additional information about people who are deaf or hard of hearing or who have speech impairments, the existence of Silver Hill Hospitals complaint resolution process, and any other requirements of this Agreement applicable to such Hospital Personnel.

55. Silver Hill Hospital will make this training mandatory for the following categories of Hospital Personnel:

A. All Program Administrators;

B. All Personnel who work with or volunteer with the Program Administrators;

C. All persons who will be responsible for training other Hospital Personnel concerning the Program; and

D. All personnel who work with or volunteer in the Admissions Office (including inpatient and outpatient registration).

56. Silver Hill may choose to discharge its training obligation by requiring appropriate personnel to view a videotape that covers the training topics required by this Agreement for that audience.

57. Psychiatric Personnel and Social Workers. Silver Hill specializes in psychiatric services. In addition to the subjects specified in paragraph 54 above, Silver Hill Hospital will provide specialized mandatory in-service training to all Hospital Personnel who work directly or indirectly with psychiatric and social services and who have Patient responsibility.3 This training will include the following objectives: to promptly identify communication needs and preferences of Patients and Companions who are deaf or hard of hearing or who have speech impairments; to secure qualified interpreter services as quickly as possible when necessary; and to facilitate appropriate interaction between Patients who are deaf or hard of hearing or who have speech impairments and other Patients, when appropriate (e.g., group therapy sessions and other times when interaction with persons other than Hospital Personnel is encouraged). Such training shall be provided within ninety (90) days of the effective date of this Agreement and annually thereafter.

58. Other Key Personnel. Special training will be given to the following Hospital Personnel not otherwise trained as provided above: all clinical directors and nursing supervisors; and the General Information desk; all triage nurses and other triage professionals; and all heads of each department in which communication with Patients occurs. Such training will cover all of the subject matters listed above in paragraph 54. Such training shall be provided within ninety (90) days of the effective date of this Agreement and annually thereafter.

59. Operators. All Hospital Personnel who receive incoming telephone calls from the public will receive special instructions on using TTYs and the telephone relay service to make and receive calls to and from persons using TTYs.

60. Training Sessions for Affiliated Physicians and Other Professionals. Silver Hill Hospital will annually conduct one or more training sessions on the communication and psychological needs of persons who are deaf or hard of hearing or who have speech impairments, and will invite all physicians and other professionals who are affiliated in any way with Silver Hill Hospital (psychiatrists, psychologists, etc.) to attend. Training videotapes that contain substantially similar information shall also be provided to any affiliated physician or other professional upon request.

61. Written Materials Distributed to Affiliated Physicians and Other Professionals. Within ninety (90) days of the effective date of this Agreement, Silver Hill Hospital will distribute a set of materials to all affiliated physicians and other professionals. These materials will contain at least the following: Silver Hill Hospital's policy statement and any relevant forms; a description of the Program; and a request that physicians' and other professionals staff notify Silver Hill Hospital of those Patients and Companions who are deaf or hard of hearing or who have speech impairments as soon as they schedule admissions, tests, or other health care services at Silver Hill Hospital.

62. Education for Others. Silver Hill Hospital will develop and implement an internal program that will provide appropriate training to all Hospital Personnel not trained under the preceding sections. This training will take place at such times as may be necessary to permit Silver Hill Hospital to meet all of its obligations under this Agreement.

63. General Training Provisions. Silver Hill Hospital will provide the training specified above to new Hospital Personnel within a reasonable time after the commencement of their services for Silver Hill Hospital. Such training shall be comparable to training provided to specific departments as necessary. A screening of a video of the original training will suffice to meet this obligation.

REPORTING, MONITORING AND VIOLATIONS

64. Silver Hill Hospital will keep appropriate records to document response times for each request for interpreters, CART, and assistive listening devices. Silver Hill Hospital shall provide such documentation to the Department upon reasonable written notice.

65. Hospital Compliance Reports. Six (6) and twelve (12) months following the effective date of this Agreement, and annually thereafter, Silver Hill Hospital shall provide a written report (a Report) to the Department regarding its status complying with this Agreement. The Report shall include reference by paragraph number to each deadline in the Agreement, the date the deadline was met, and a description of how Silver Hill Hospital met each requirement. Silver Hill Hospital will also include data relevant to the agreement, e.g., the number of assessments provided, the number of complaints, the number of times an interpreter was provided and denied and the circumstances, and the timeliness in responding to the need for an interpreter and making needed equipment available. Silver Hill Hospital will attach to the Report copies of other documents relevant to this Agreement, e.g., notices, policies, updated handbooks, and training materials. Silver Hill Hospital may also include information regarding other efforts made to comply with the ADA, such as acquisition of updated equipment. Silver Hill Hospital shall make the Report available for public inspection in the admissions office. Silver Hill Hospital shall maintain appropriate records to document the information contained in the Report.

66. Right of Compliance Review. During the term of this Agreement, the United States may, upon reasonable advance notice to a Silver Hill Hospital Program Administrator from time to time, inspect Silver Hill Hospital premises and review Silver Hill Hospital's compliance with this Agreement. As a part of such review, the United States may, with reasonable notice and in a reasonable manner that protects patient confidentiality rights and avoids interfering with patient care and other hospital services, require Silver Hill Hospital to permit the United States to interview Hospital Personnel, Patients and Companions who are deaf or hard of hearing or who have speech impairments or others associated with them, and other persons with knowledge relating to implementation of this Agreement, to the extent reasonably necessary to determine whether Silver Hill Hospital is complying with the provisions of this Agreement. Silver Hill Hospital will retain during the life of this Agreement all records required to be maintained by this Agreement. Silver Hill Hospital will produce such records for the purpose of photocopying if and when requested by the United States, unless doing so would unduly burden or disrupt Silver Hill Hospitals normal business operations, in which case Silver Hill Hospital will identify the burdens or disruptions and make a good faith effort to cooperate with the United States to ameliorate those disruptions or burdens while allowing the United States appropriate access to the records. No such records shall be produced in violation of applicable law or without any legally required consents, and any records containing confidential information that are produced shall be kept confidential by the United States. Nothing herein is intended to, nor shall, limit, extend or expand the investigatory or compliance review powers of the United States otherwise provided by law.

Violation of Agreement

67. If Silver Hill Hospital violates this Agreement or any subpart of this Agreement, the United States shall have all such remedies as are allowed under the ADA and the Rehabilitation Act, provided that the first such violation by Silver Hill Hospital shall be deemed a first violation of the ADA for the purpose of calculating civil penalties, if any.

68. Notwithstanding the provisions of paragraph 67 above, in the event that the United States believes that Silver Hill Hospital has violated any provision of this Agreement, it shall give notice (including reasonable particulars) of such violation to Silver Hill Hospital's Chief Executive Officer, and Silver Hill Hospital shall then respond to such notice and/or cure such non-compliance as soon as practicable but no later than 30 days thereafter. Any event of non-compliance that prevents or restricts a Patient from receiving urgent health care services shall be cured without delay. The Parties shall negotiate in good faith in an attempt to resolve any dispute relating thereto before seeking relief under paragraph 67 above, but the United States may seek damages and civil penalties for any breach of this Agreement that has resulted in discrimination or injury to a particular person.

69. Compensatory and Injunctive Relief for United States Complainant.

Within ten (10) days of the effective date of this Agreement, Silver Hill Hospital will deliver a check in the amount of $25,000 payable to the individual United States Complainant. The check is compensation for alleged discrimination against United States Complainant who is deaf or hard of hearing. Simultaneous with the mailing of the check, Silver Hill Hospital will provide to the Department of Justice a copy of the check for its records.

RELEASES

70. General Release. Any and all claims, proceedings, and causes of action for damages, penalties, attorneys fees, interest, costs, declaratory, injunctive or other relief arising out of the transaction or series of transactions that gave rise to this Agreement and not expressly provided for by this Agreement, except for those expressly reserved in this Agreement, are released.

71. Release of United States Complainant. Silver Hill Hospital releases United States Complainant of any and all monetary claims for services rendered to date.

72. Release by United States Complainant. Within fifteen (15) days of final signature of this Agreement, the United States will deliver appropriate release to counsel for Silver Hill Hospital on behalf of its Complainant. The release will be substantially in the form of Exhibit 3 hereto.

MISCELLANEOUS PROVISIONS

73. Disclaimer of Liability. Nothing in this Agreement shall be construed as an admission by Silver Hill Silver Hill Hospital of any liability or fault, that it engaged in any wrongful or illegal activity, that any of the United States allegations are true, or that any person suffered any injury as a result of the events as alleged by the United States. This Agreement shall not be offered or received in evidence in any action or proceeding in any court or other tribunal as an admission or concession of liability or wrongdoing of any nature on the part of Silver Hill Hospital, except in an action challenging Silver Hill Hospitals compliance with this Agreement.

74. Term of the Agreement. This Agreement shall remain in effect for three (3) years, after which time its provisions shall be terminated.

75. Effective Date. The effective date of this Agreement shall be the date of the last signature, below.

76. Public Agreement. This Agreement, along with its exhibits, constitutes a public agreement and a copy of the Agreement, or any information concerning its contents (except where privileged or confidential by law), may be made available to any person.

77. Changing Circumstances. During the three (3) years in which this Agreement will be in effect, there may be a change in circumstances such as, for example and without limitation, an increased or decreased availability of qualified sign language or oral interpreters or developments in technology to assist or improve communications with persons who are deaf or hard of hearing or who have speech impairments. If Silver Hill Hospital determines that such changes create opportunities for communicating with Patients and Companions who are deaf or hard of hearing or who have speech impairments more efficiently or effectively than is required under this Agreement, or create difficulties not presently contemplated in the provision of appropriate auxiliary aids and services, it may seek approval to modify this Agreement by presenting written notice to the Department, which approval will not be unreasonably withheld. Both Parties shall negotiate in good faith prior to modification of this Agreement.

78. Binding. This Agreement is final and binding on both Parties, including all principals, agents, executors, administrators, representatives, successors in interest, beneficiaries, assigns, heirs and legal representatives thereof. Each Party has a duty to so inform any such successor in interest.

79. Non-Waiver. Failure by either Party to seek enforcement of this Agreement pursuant to its terms with respect to any instance or provision shall not be construed as a waiver to such enforcement with regard to other instances or provisions.

80. Counterparts. This Agreement may be executed in one or more counterparts, each of which shall be deemed to be an original but all of which together shall constitute one and the same instrument.

81. Compliance. If Silver Hill Hospital performs its obligations under this Agreement, it shall be deemed by both Parties to have fulfilled its obligations under the ADA and the Rehabilitation Act regarding communication with Patients and Companions who are deaf or hard of hearing or who have speech impairments, for purposes of any remedy that may be available to the Parties for any alleged violation of such obligations by Silver Hill Hospital.

82. Severability. In the event that a Court shall determine that any provision of this Agreement is unenforceable, such provision shall be severed from this Agreement and all other provisions shall remain valid and enforceable; provided, however, that if the severance of any such provision shall materially alter the rights or obligations of both Parties hereunder, they shall, through reasonable, good faith negotiations, agree upon such other amendments hereto as may be necessary to restore both Parties as closely as possible to the relative rights and obligations initially intended by them hereunder.

83. The person signing for Silver Hill Hospital represents that she or he is authorized to bind the Hospital to this Agreement.

1. FSW is a non-profit family services agency accredited by the National Council on Accreditation of Services for Families and Children, Inc. (return)

2. Such training shall include instruction regarding how to communicate in writing with persons who are deaf or hard of hearing or who have speech impairments. For example, depending on the written communication skills of the person, it may be necessary to write in complete sentences, use legible handwriting, use special efforts to make the communication as thorough, precise, and dignified as oral communication with others would be, or refrain from using abbreviations or medical symbols (e.g., arrows instead of "increase" or "decrease" or mathematical symbols for "less than" or "greater than"). Silver Hill Hospital agrees to provide writing utensils and paper for inpatients who are deaf or hard of hearing or who have speech impairments, to facilitate communication with Hospital Personnel. (return)

INDEX OF SCHEDULES and EXHIBITS

2. Example of Sign with International Symbols for interpreters and TTYs

3. Sample United States Complainant Release

SCHEDULE A

I. TTYs in Public Areas and Specific Locations

A. If an acoustic coupler is used for a permanently affixed TTY, the telephone cord shall be sufficiently long to allow connection of the TTY and the telephone receiver.

B. If an acoustic coupler is used for a portable TTY, the telephone handset cord shall be sufficiently long so as to allow connection of the TTY and the telephone receiver.

II. Shelves and Outlets

A. Telephones designed to accommodate a portable TTY shall be equipped with a shelf and an electrical outlet within or adjacent to the telephone enclosure. The telephone handset shall be capable of being placed flush on the surface of the shelf. The shelf shall be capable of accommodating a TTY and shall have 6 inches (152 mm) minimum vertical clearance in the area where the TTY is to be placed.

III. Signs Indicating Location of TTYs

A. TTYs shall be identified by the international TTY/TDD symbol.

B. At all public telephone locations, signs posted to indicate the availability of permanently affixed TTYs and signs which provide direction to or information about the location of TTYs shall satisfy the following requirements:

1. Character Proportion. Letters and numbers on signs shall have a width-to-height ratio between 3:5 and 1:1 and a stroke-width-to-height ratio between 1:5 and 1:10.

2. Character Height. Characters and numbers on signs shall be sized according to the viewing distance from which they are to be read. If a sign is to be suspended overhead, the minimum height shall be 3 inches (or 75 mm), as measured using an upper case X. Lower case characters are permitted.

3. Finish and Contrast. The characters and background of signs shall be eggshell, matte, or other non-glare finish. Characters and symbols shall contrast with their background - either light characters on a dark background or dark characters on a light background.

4. Mounting Height and Location. Mounting height shall be 60 inches (1525 mm) above the finish floor to the centerline of the sign. Mounting location for such signage shall be so that a person may approach within 3 inches (76 mm) of signage without encountering protruding objects or standing within the swing of a door.

IV. Volume Control

A. Telephones required to have a volume control shall be identified by a sign containing a depiction of a telephone handset with radiating sound waves. These signs shall comply with the requirements set forth in Section III.B., above.

B. Public area and patient room telephones required to have a volume control shall be capable of a minimum of 12 dbA and a maximum of 18 dbA above normal volume. If an automatic reset is provided then 18 dbA may be exceeded.

SCHEDULE B

I. Visual Alarms

B. Visual alarm signal appliances shall be integrated into the building or facility alarm system. If single station audible alarms are provided then single station visual alarm signals shall be provided. Visual alarm signals shall have the following minimum photometric and location features:

(3) The maximum pulse duration shall be two-tenths of one second (0.2 sec) with a maximum duty cycle of 40 percent. The pulse duration is defined as the time interval between initial and final points of 10 percent of maximum signal.

(7) In general, no place in any room or space required to have a visual signal appliance shall be more than 50 feet (15 m) from the signal (in the horizontal plane). In large rooms and spaces exceeding 100 feet (30 m) across, without obstructions 6 feet (2 m) above the finish floor, such as auditoriums, devices may be placed around the perimeter, spaced a maximum 100 feet (30 m) apart, in lieu of suspending appliances from the ceiling.

(8) No place in common corridors or hallways in which visual alarm signaling appliances are required shall be more than 50 feet (15 m) from the signal.

C. Patient rooms into which portable visual alarms are to be placed shall have a standard 110-volt electrical receptacle into which such alarm can be connected and a means by which a signal from the building emergency alarm system can trigger such a portable alarm. When visual alarms are in place the signal shall be visible in all areas of the unit or room. Instructions for use of the auxiliary alarm or receptacle shall be provided.

Exhibit 1
Model Communication Assessment Form

________________________________________________Name of Person with Disability
(deaf, hard of hearing, or speech impairment)

________________________________________________Patients Name

Nature of Disability:

___ Deaf

___ Hard of Hearing

___ Speech Impairment

___ Other: ____________________

Relationship to Patient:

___ Self

___ Family member

___ Friend

___ Other: ____________________________

Do you want a professional sign language or oral interpreter?

___ No. I do not use sign language and do not use interpreters to lip read.

___ No. I prefer to have family members/ friends help with communication.

___ Yes. Choose one (free of charge):

___ American Sign Language (ASL)

___ Signed English

___ Oral interpreter

___ Other. Explain: ___________________________________________

Which of the following would be helpful for you? (free of charge)

___ TTY/TDD (text telephone)

___ Assistive listening device (sound amplifier)

___ CART: Computer-assisted Real Time Transcription

___ Qualified note-takers

___ Writing back and forth

___ Other. Explain: _________________________________________

If you, or the Patient who you are with, is ADMITTED to Silver Hill Hospital, which of the following will you want in the patient room?

___ Telephone handset amplifier

___ Telephone compatible with hearing aid

___ Closed caption decoders for television set

___ TTY/TDD

___ Flasher for incoming calls

___ Paper and pen for writing notes

___ Other. Explain: ___________________________________________

We ask this information so we can communicate with you effectively. All communication aids and services are provide FREE OF CHARGE. If you need further assistance, please ask your nurse or other hospital personnel.

Any questions? Please call our Effective Communication Program Office, ______________(voice), ______________ (TTY), or visit us during normal business hours. We are located in room ___________________________________.

EXHIBIT 2

Sign language and oral interpreters, TTY's, and other auxiliary aids and services are available free of charge to people who are deaf or hard of hearing or who have speech impairments.

For assistance, please go to the nearest nurses station or contact any Hospital
personnel or the Program Office at ______________ (voice/TTY), room ____________.

EXHIBIT 3

[UNITED STATES COMPLAINANT RELEASE]

RELEASE

TO ALL WHOM THESE PRESENTS MAY COME OR MAY CONCERN, KNOW THAT I, _______________________ (Releasor), for and in consideration of the sum of Twenty-Five Thousand Dollars and No Cents ($25,000), lawful money of the United States of America to me in hand paid, and other good and valuable consideration, the receipt whereof is hereby acknowledged, have remised, released and forever discharged, and by these presents do for myself, my successors and assigns, hereby remise, release and forever discharge, SILVER HILL HOSPITAL and each of their agents, officers, employees, and medical and professional staff, and the heirs, executors, administrators, successors and assigns, of and from all actions, causes of action, suits, debts, dues, accounts, covenants, agreements, claims and demands whatsoever, which I ever had, now have, or hereafter may have, including, without limiting the generality of the foregoing, derivative claims that my family might have arising out of my treatment at Silver Hill Hospital , and further, the release and discharge of any and all claims made by me in a complaint filed with the United States Department of Justice bearing the DJ # 202-14-44, excepting only timely claims of medical negligence or malpractice.

IN WITNESS WHEREOF, I have hereunto set my hand and seal this ___ day of ________ 2002.

Signed, sealed and delivered
in the presence of:

____________________________(L.S.) _________________________________

STATE OF CONNECTICUT )
): ss _________ ___ , 2002
COUNTY OF NEW HAVEN )

Personally appeared _______________________________, signer and sealer of the foregoing instrument, and acknowledged the same to be her free act and deed, before me.